“I administered CPR,” he says. “But we lost our son.”

Soon after Eric died, his parents learned that although he had always seemed healthy, he’d had an undetected heart condition.

Like Eric, an estimated 356,000 people in the U.S. have a sudden cardiac arrest each year – and many of those cases are fatal. It’s not clear how many are kids or teens. But the number could be as high as 23,000, researchers reported in 2020.

And 1 in 300 youths have an undetected heart condition that puts them at risk, the American Heart Association says.

“We’re losing a lot of kids,” Paredes says. “Families get destroyed. It affects parents, friends, siblings.”

Could a simple screening – four questions – help identify those children and prevent a tragedy?

What Happens in Sudden Cardiac Arrest

Sudden cardiac arrest or death (SCA/D) happens when the heart’s electrical system goes haywire, triggering a sudden, dangerous rhythm problem. It’s not the same as a heart attack.

Trying to figure out how to screen for the conditions that make SCA/D more likely has been an ongoing process. The American Heart Association developed a pre-participation physical for student athletes, but it wasn’t getting enough attention, says Christopher Erickson, MD, a pediatric electrophysiologist at Children’s Nebraska Specialty Pediatric Center. Surveys showed that many primary care doctors didn’t even know it existed.

The American Academy of Pediatrics (AAP) has tried to address that with its own recommended screening process. Erickson co-led a team of experts who released the most recent version, in 2021. It features a four-question test that is designed to be simple and quick. It’s also meant to be used for all children – not just those who play organized sports – at least every three years, from when the student starts middle school.

“All children are athletes, meaning they are very active in play, games, and different sports,” says cardiologist Victoria Vetter, MD, one of the experts who worked with Erickson on the AAP’s 2021 recommendations. Vetter is the medical director of Youth Heart Watch, a sudden cardiac death prevention program at the Children’s Hospital of Philadelphia.

The 4 Questions, Explained

Here are the four questions recommended by the AAP:

1) Have you ever fainted, passed out, or had an unexplained seizure suddenly and without warning, especially during exercise or in response to sudden loud noises such as doorbells, alarm clocks, and ringing telephones?

This question aims to identify people who may have long QT syndrome, a heart rhythm disorder that often causes fainting. Long QT syndrome isn’t common, and people can faint or have seizures for other reasons. So it’s important to get those symptoms checked out by a doctor.

“A lot of people pass out for benign reasons,” Erickson says. But if it happens because of long QT, that puts them at much higher risk of SCA/D.

2) Have you ever had exercise-related chest pain or shortness of breath?

These are two signs that your heart might not work the way it’s supposed to, possibly because of coronary artery anomalies, Erickson says. But these symptoms can also happen because of asthma or other reasons, Vetter notes, so it’s important for a doctor to identify the cause.

4) Are you related to anyone with hypertrophic cardiomyopathy or hypertrophic obstructive cardiomyopathy, Marfan syndrome, arrhythmogenic right ventricular cardiomyopathy, long QT syndrome, short QT syndrome, Brugada syndrome, or catecholaminergic polymorphic ventricular tachycardia, or anyone younger than 50 years old with a pacemaker or implantable defibrillator?

If the conditions in this question ring a bell because of your family history, there might be a genetic risk, Erickson says.

What to Do if Any Answers Are ‘Yes’

A yes to any of the four questions should prompt a referral to a pediatric cardiologist or electrophysiologist, who can do an electrocardiogram (also called an ECG or EKG).

This painless test, which involves having electrodes attached to your chest, shows the heart’s electrical activity. Doctors can use an EKG to diagnose some heart conditions right away, and to flag other potential issues that need further testing (such as an echocardiogram), Vetter says.

In 30% to 50% of cases, children and teens who have a sudden cardiac arrest may have no warning signs or symptoms, Vetter says. That’s why she and other health advocates argue that current screening guidelines should be expanded beyond the four questions to encourage EKGs for all kids.

It’s “reasonable” to include EKGs in cardiac evaluation before kids take part in competitive sports, even if a child has no risk factors – as long as all the athletes have access to resources to check on any results, according to a recent scientific statement from the American Heart Association and the American College of Cardiology. That statement doesn’t recommend EKGs for all kids, though.

“The biggest problem is manpower and cost,” Erickson says. “Who will read all of them?”

What Parents Can Do

The goal is to learn what’s normal, what’s not, and be prepared – without overreacting about what’s going on with your child.

“You don’t need to see a doctor every time they have a chest pain,” Vetter says.

If something seems unexplained or keeps happening, she recommends telling the child’s doctor. “I am happy if they get an EKG” in that situation, Vetter says. She notes that young people’s bodies are constantly changing, and even a child with a normal test in middle school might develop an issue in high school.

Vetter’s advice: Seek out medical providers who take their time with patients. “These evaluations require nuanced expertise,” she says. “A quick sign-off is not providing the best surveillance.”

Make an Emergency Plan

There’s no perfect way to predict SCA/D. So it’s crucial to know what to do if it happens.

A nationwide campaign to “Call, Push, Shock” teaches bystanders to call 911, start CPR, and use an automated external defibrillator (AED) as soon as possible.

There’s been a spike of interest in CPR and AEDs since NFL player Damar Hamlin had a cardiac arrest during a game in 2023. And in December 2024, the HEARTS Act became law, making AEDs and CPR training more available in schools and encouraging schools to make cardiac emergency response plans.

Turning Tragedy Into Legacy

After their son’s death, Hector Paredes and Eric’s mom, Rhina, started the Eric Paredes Save A Life Foundation to raise awareness and teach communities about SCA/D. The foundation offers free heart screening events that include training in CPR and automated external defibrillators (AEDs).

“I … have a vision that one day youth heart screenings and automatic external defibrillators will be mandatory,” Hector states on the foundation’s website.

“We were never told it could be a heart issue,” Li says.

So they were surprised when Jacob got an EKG at a foundation community event and learned he had Wolff-Parkinson-White syndrome, which can cause a dangerously fast heartbeat.

Jacob needed surgery. “Now he is thriving and has no limitations whatsoever,” Li says. But she worried that other children’s symptoms are also being overlooked.

Li, who is the foundation’s co-executive director, urges parents to help support community initiatives and make sure that AEDs are accessible.

“You don’t want it locked in a drawer in the nurse’s office,” she says.

https://www.webmd.com/heart-disease/features/sudden-cardiac-arrest-risk-screening-tweens-teens